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Source: (consider it)
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Thread: Purgatory: Health Care
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RadicalWhig
Shipmate
# 13190
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Posted
On the "Obama: Why so angry" thread, amongst a more general discussion of the levels of anger and division in US politics, there has been some discussion of Obama's health care reform plan. To avoid derailing that thread, I thought it might be a good idea to start a separate thread for the discussion of health care issues more generally.
What strikes me about Obama's plan is how very moderate and limited it is: it does not really amount to a "public health care system", so much as "increased regulation of a private health care system to make it a tiny little bit more fair". Nancy-Ann DeParle has talked about "reforming the health care market" and "building on the uniquely American employer-based system". To me, Obama's proposals seem like an absolute minimum for a civilised community. It still leaves a for-profit health system in place which (largely) ties coverage to employment.
There have been comparisons to the British NHS, which seems to be what so many Americans are (perhaps rightly) opposed to: a centralised system of direct State provision, with patients having very little choice.
The best health care system I have ever used is the French system: a single-payer system in which patients get maximum choice of care, while the bills are picked up by the State.
Coming back to the UK after living in France, the poor standard of the NHS system struck me. It is great that it is universal. It is great that there is no up-front cost. However, the quality and choice do inevitably suffer when compared to the French single-payer system.
My wife has a chronic, non-life-threatening, non-debilitating, but quite annoying condition which is easily treatable, but which if untreated can get worse and sometimes restrict her ability to work. In France, she was recieving weekly sessions of treatment at a local clinic; for this, we paid a small fee, almost all of which was reimbursed by the State. In the UK, she had to wait several months for a first treatment, and then was told that they would "see her again in a year"; this means that we have to go private, which is horrendously expensive in the UK because the private sector is squeezed out.
I would abolish the NHS in a flash; that is, I would gladly scrap the system of direct public provision in favour of a public single-payer system. In my opinion, that seems like the best way to ensure that universal free-at-the-point-of-delivery health care is provided while maintaining patient choice and high standards.
What is your view?
[ 21. June 2010, 17:34: Message edited by: Barnabas62 ]
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Radical Whiggery for Beginners: "Trampling on the Common Prayer Book, talking against the Scriptures, commending Commonwealths, justifying the murder of King Charles I, railing against priests in general." (Sir Arthur Charlett on John Toland, 1695)
Posts: 3193 | From: Scotland | Registered: Nov 2007
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five
Shipmate
# 14492
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Posted
I can't compare the NHS to France, having never lived there. But comparing the NHS to the USA, where my family deals with health insurance as an issue quite frequently, I'm constantly shocked at how mis-perceived the NHS is there and also how many people think that the people least able (the sick, the disabled, the elderly) should be paying through the nose for care. When they can't, the results are catastrophic, not just for the patient, but for the society. Things that are easily rectified in a GPs office, or a minor treatment just don't happen as to walk through the door of a doctor's office without health insurance means you can be turned away. Many doctors wont' even accept "let me put that on my credit card" which I found truly amazing.
With 10 of the USA out of work, and therefore presumably without health insurance, and as this increasingly affects the middle class (by driving up their premiums, and also by their suddenly not having insurance through losing their jobs), I would have thought they'd be desperate to ensure at least some basic health care.
The NHS isn't perfect, but I'd never get rid of it. The stresses and strains and worry (and bills! Don't forget that all this private health care is paid for by companies that are basically there to decide what they're not going to cover, and your co-payments to keep you on your toes as the premiums aren't enough) of the USA system seem horrible to me.
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And Jesus said 'the greatest commandments are these: Love the Lord your God with 10% of your time and energy, and Pamphlet your neighbour with tracts' - Birdseye
Posts: 1250 | Registered: Jan 2009
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Hawk
Semi-social raptor
# 14289
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Posted
quote:
Originally posted by RadicalWhig:
I would gladly scrap the system of direct public provision in favour of a public single-payer system.
Could you explain to me the difference between the two? I assumed NHS was single-payer.
And your description of the French system of making the patient pay up front and then wait to get partially reimbursed by the state doesn't seem that brilliant to me. Could you explain to me why this is better, or if there's any other reason why the French system is better? Is this the only reason why the French can treat your wife quicker and better, because you're paying for part of it? Or is their system of managing the service just less cumbersome and overstretched than the NHS? Do you know any other details of how the French system works other than your personal experience as an end user?
In general, I love the idea of walking into a doctors and getting professional service and care without anyone once mentioning cost. It's a brilliant feeling, and it's available to everyone, rich, poor, citizen or illegal immigrant. The most pure example I know of the true purpose of a state, to serve its citizens. It might need reforming if its not as efficient as the French system you describe but it certainly doesn't need to be scraped. Perhaps just extended and expanded to pay for more things and more personnel so your wife can be cared for as she should be.
And I too am astonished, both at how flimsy and lightweight Obama's proposals are, and the corresponding excess of of vitriol his opponents have thrown at it. He really isn't doing much at all when you look at the details. Even if he gets the proposals through America will still have a frighteningly poor healthcare system.
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“We are to find God in what we know, not in what we don't know." Dietrich Bonhoeffer
See my blog for 'interesting' thoughts
Posts: 1739 | From: Oxford, UK | Registered: Nov 2008
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opaWim
Shipmate
# 11137
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Posted
quote:
Originally posted by RadicalWhig:
Coming back to the UK after living in France, the poor standard of the NHS system struck me. It is great that it is universal. It is great that there is no up-front cost. However, the quality and choice do inevitably suffer when compared to the French single-payer system.
What do you mean by "single-payer system"?
Is the French system comparable to what I described of the Dutch system in the other thread?
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It's the Thirties all over again, possibly even worse.
Posts: 524 | From: The Marshes | Registered: Mar 2006
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RadicalWhig
Shipmate
# 13190
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Posted
Five: I think we can agree that the present US system is the worst of all worlds, and that the NHS is superior to that. The Obama plan, while beneficial, seems not to go far enough; it keeps the insurance companies in place. Politically, given the power of corporate interests, it is probably as far as Obama can go.
I wouldn't want to get rid of the principle of universal, free-at-the-point-of-delivery health care. That principle is sacred. But, to improve how the principle of universal free-at-the-point-of-delivery health care is delivered, I would like to give serious consideration to the idea of having a public single-payer system (universal public health insurance) rather than a public direct-provision system in the UK.
On reflection, my "I'd abolish the NHS in a flash" comment was too hasty. I don't know for certain single payer is necessarily the best option. It does seems to work well in France and it does also appear to offer many advantages over both the American (corporate-led) and British (State-led) systems, so it ought to be seriously considered, but that's all. "I would seriously consider abolishing the NHS in a flash" would be closer to the truth.
There is some information on single-payer systems here. and here.
(OMG, it is past noon and I have done almost no work today. Right, I need to go and become a productive member of society for a few hours!).
[ 11. August 2009, 11:15: Message edited by: RadicalWhig ]
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Radical Whiggery for Beginners: "Trampling on the Common Prayer Book, talking against the Scriptures, commending Commonwealths, justifying the murder of King Charles I, railing against priests in general." (Sir Arthur Charlett on John Toland, 1695)
Posts: 3193 | From: Scotland | Registered: Nov 2007
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Honest Ron Bacardi
Shipmate
# 38
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Posted
I have only had limited involvement with the French system, but my general impression is that yes - overall it delivers rather better than the British NHS.
However, it also costs a lot more I believe. 20% straight off all income, more if you are self-employed. I can't track the government contribution figures immediately, but the point I'm trying to make is that one has to compare like with like - if we are only prepared to expend an average of £x per head on health, we should not be surprised if another country spending £1.5x per head (say) gets a better service.
Also, you only get full reimbursement of charges under certain circumstances. Otherwise you have to fork out the difference yourself or carry insurance that will do that. This table claims to have current reimbursement rates.
I guess what I am driving towards is that a proper consideration would need to involve a full SWOT analysis of sorts. The risk is to pick one of the weaker points of one system and compare it unfavourably with another preferred system on that point alone. That would equally describe much American criticism of Obama's planned reforms.
But the inherent structuring of the French system around choice at the point of delivery, and single direct payment does offer considerable advantages, I agree.
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Anglo-Cthulhic
Posts: 4857 | From: the corridors of Pah! | Registered: May 2001
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Horseman Bree
Shipmate
# 5290
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Posted
When Saskatchewan brought the beginnings of our present Medicare in Canada, back in the 1960's, doctors went on strike or left the province, the insurance industry went berserk, and the right-wing mouthies foamed away.
But then the doctors who stayed found that they were actually paid, unlike the previous situation of having to accept chickens or wait for loan arrangements or not get paid at all. People found that the system actually worked, and that they could all get in.
And the program developed across the country. Pearson was able to get Medicare through Parliament, despite being in a minority government.
We've now had a couple of generations of the service,and people are used to it.
The change has been that the right-wingers want to be "free" of taxes, even though our tax load is actually no worse than the US, and it includes paying for full Medicare. But some people don't want to pay anything for anything.
The last stats I saw showed that the US governments actually spend more per capita on health care than the Canadian gov'ts do, and then you add the cost of insurance on top of that. So whatever "system" it may be in the US, it is somewhere between 50% and 100% more expensive than the Canadian model - and we're by no means the most efficient!
And our outcomes tend to be better - lower infant mortality, longer lifespan....
And present communications make it easier to get your message out, however untrue or weird it may be.
Posts: 5372 | From: more herring choker than bluenose | Registered: Dec 2003
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opaWim
Shipmate
# 11137
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Posted
After reading this
http://en.wikipedia.org/wiki/Single-payer_health_care
I think I understand.
The Netherlands have a mixed system where (very generally speaking) the short-term health-care is paid/reimbursed through the insurance-companies, and the longer-term health-care through a tax on income.
At first sight the cost seems about the same or slightly less than the French system.
We have freedom of choice where to get our health-care. The system is not (directly) state-controlled, but the government interferes a lot to try keep the cost down, sometimes with success, sometimes counter-productively.
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It's the Thirties all over again, possibly even worse.
Posts: 524 | From: The Marshes | Registered: Mar 2006
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Imaginary Friend
Real to you
# 186
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Posted
Being that I don't follow the details of US political debate, I don't really know the intricacies of what Obama is proposing. Would it be possible for someone to post a brief summary of the plan?
Many thanks. ![[Smile]](smile.gif)
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"We had a good team on paper. Unfortunately, the game was played on grass."
Brian Clough
Posts: 9455 | From: Left a bit... Right a bit... | Registered: May 2001
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Hawk
Semi-social raptor
# 14289
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Posted
quote:
Originally posted by davelarge:
Would it be possible for someone to post a brief summary of the plan?
A brief summary? Almost impossible I'm afraid. The full proposal is still being debated, there are three versions of the bill and the debate is fighting to preventy itself being derailed by vast quantities of misinformation being posted by right-wing bloggers, newspapers and even republican politicians. This is the simplest summary of the House' proposal. But to get a good picture of what's going on you'll need to read a lot more.
[ 11. August 2009, 12:23: Message edited by: Hawk ]
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“We are to find God in what we know, not in what we don't know." Dietrich Bonhoeffer
See my blog for 'interesting' thoughts
Posts: 1739 | From: Oxford, UK | Registered: Nov 2008
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ken
Ship's Roundhead
# 2460
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Posted
quote:
Originally posted by Hawk:
It might need reforming if its not as efficient as the French system ...
The NHS is a lot more efficient than the French system. It is also a lot cheaper. We pay a lot less than they do, we get almost as much as they do. So we get more healthcare for our money.
The real losers are the Americans who pay more tax for their healthcare than we do and then pay as much insurance as the French or the Germans on top of that.
To put it crudely we are paying for 60% of a decent modern healthcare service and we are getting 80% of one. The Americans are paying 120% and only getting 60%
The French are paying for 100% of it and are getting what they pay for. Which is one reason they live longer than we do on average.
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Ken
L’amor che move il sole e l’altre stelle.
Posts: 39579 | From: London | Registered: Mar 2002
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Honest Ron Bacardi
Shipmate
# 38
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Posted
OK - some stats.
Total expenditure on health services by country:
UK - 8.4% of GDP
France - 11.0% of GDP
USA - 16% of GDP
OECD average - 8.9% of GDP
(source - OECD Health Data 2009)
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Anglo-Cthulhic
Posts: 4857 | From: the corridors of Pah! | Registered: May 2001
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Pokrov
Shipmate
# 11515
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Posted
quote:
Originally posted by ken:
To put it crudely we are paying for 60% of a decent modern healthcare service and we are getting 80% of one
Well put Ken. And I would suggest that it's mainly in primary care where this magical process occurs.
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Most Holy Theotokos pray for us!
Posts: 1469 | Registered: Jun 2006
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Clint Boggis
Shipmate
# 633
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Posted
quote:
Originally posted by Horseman Bree:
The last stats I saw showed that the US governments actually spend more per capita on health care than the Canadian gov'ts do, and then you add the cost of insurance on top of that. So whatever "system" it may be in the US, it is somewhere between 50% and 100% more expensive than the Canadian model - and we're by no means the most efficient!
And our outcomes tend to be better - lower infant mortality, longer lifespan....
I don't think anyone would try to argue that the US 'system' yields better outcomes overall but it almost certainly does for those with continuing good health who haven't reached their insurance payout limit. I'm sure figures for health outcomes for those with good cover exist and those are the ones people with cover care about when comparing the US health with other countries. They don't mention them because they can't say "yeah, but if poor people get sick, who gives a shit?", even if they're thinking it.
Keep the NHS! It's one of the things which characterises this country: flawed, cheap and generally does the job while being misrepresented by the press. If we were willing as a country to spend more on heath care we'd get more choice and shorter waits but these are icing on the cake compared with a civilised system which provides cover for all - at a knock-down price.
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Posts: 1505 | From: south coast | Registered: Jun 2001
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Josephine
Orthodox Belle
# 3899
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Posted
quote:
Originally posted by Clint Boggis:
I don't think anyone would try to argue that the US 'system' yields better outcomes overall but it almost certainly does for those with continuing good health who haven't reached their insurance payout limit.
Provided that the insurance company hasn't decided to cancel your coverage or deny your claim.
We've got some experience of that. In fact, I dare say that most people who have ever had to use their medical insurance have that experience.
It boggles my mind how expensive our health care coverage is, and how little we get for it.
It also boggles my mind that so many people believe the things in the hysterical emails that are circulating the Internet.
I've called my senators and congresscritter. I've donated a small amount of cash to Move On to help fund the fight for health care reform.
The status quo is both unjust and unsustainable. We shouldn't tolerate it. It has to be changed. But the insurance companies -- which would cease to exist under a single payer plan -- have loads of money, and money buys power.
I don't know what else I can do.
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I've written a book! Catherine's Pascha: A celebration of Easter in the Orthodox Church. It's a lovely book for children. Take a look!
Posts: 10273 | From: Pacific Northwest, USA | Registered: Jan 2003
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New Yorker
Shipmate
# 9898
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Posted
Just a clarification: Obama does not have a health reform plan. The House has one and there are several Senate plans floating around. What Obama is touting I am not sure since he admitted that he has not read the House plan.
Posts: 3193 | From: New York City | Registered: Jul 2005
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Erin
Meaner than Godzilla
# 2
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Posted
I think what scares a lot of people -- and, quite frankly, it scares the hell out of me, too -- is the idea that the government will just expand our current Medicare program instead of actually putting together some kind of logical system. US Medicare is probably the worst health plan out there, to be honest. They have price controls in place that literally do not even cover the actual cost of the services; there are more regulations to adhere to than the US tax code; they contract through regional carriers and fiscal intermediaries who all interpret Medicare requirements differently, which leaves you screwed if you are like my employer and have three different FIs and another three different carriers to deal with from one billing platform. If what ultimately comes out of all of this is expanded Medicare, I will be the first to take up arms against the government.
I linked to this in the other thread, and I think it bears relinking here. Denise Cortese, President and CEO of Mayo Clinic, talks about the current healthcare crisis and what we need to do to survive it. Some very good suggestions.
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Commandment number one: shut the hell up.
Posts: 17140 | From: 330 miles north of paradise | Registered: Mar 2001
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Amorya
Ship's tame galoot
# 2652
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Posted
The key point of the NHS, for me, is to know that you will never be hit by a surprise bill for being ill.
The other year I broke my finger. Didn't realise at first, after a few days of pain I toddled off to the doctor's office, where they promptly told me to get myself down to the hospital. I jumped on a bus, sat in line at the waiting room, and after a few hours they gave me an X-ray, bandaged me up, and scheduled an appointment for next week for some physio.
I was a poor student at the time. If I'd had to pay anything, even if the cost was relatively small, I probably wouldn't have gone. "It's OK, my finger hurts, but I can deal." That's even if it was a system that refunded the cost later, because I would have hated the risk that I might not be refunded. Turns out that without treatment I would almost certainly have lost the use of my finger.
That's why I love the NHS. It's good enough, even if it's not absolutely super. It guarantees that however much of a mess I get into, I won't have to pay loads to sort it out. But the thing is, we have private healthcare here too, if you want to jump NHS queues or whatever, and you can get insurance to cover it. Surely that's the best of both worlds?
Amorya
Posts: 2383 | From: Coventry | Registered: Apr 2002
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Imaginary Friend
Real to you
# 186
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Posted
quote:
Originally posted by Amorya:
That's why I love the NHS. It's good enough, even if it's not absolutely super. It guarantees that however much of a mess I get into, I won't have to pay loads to sort it out.
I think that's a crucial point, and we've got to remember that (realistically speaking) there is no such thing as a perfect healthcare system. There will always be finite resources, people will always make mistakes (just because they are people), and everybody has to die sometime.
But for me, the clincher with public healthcare is that it makes it possible to invest (and that is the correct word, in my opinion) in preventative medicine. It makes sense that treating people when the issue becomes acute (and therefore urgent) is by far the most inefficient way go. But that goes against everything that an insurance company (who's main purpose is to make money for their shareholders) stands for: You don't pay out unless you have to.
Hawk - thanks for that link. I shall go and read it now.
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"We had a good team on paper. Unfortunately, the game was played on grass."
Brian Clough
Posts: 9455 | From: Left a bit... Right a bit... | Registered: May 2001
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five
Shipmate
# 14492
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Posted
My cousin in the USA is, sadly a we-hope-former crystal meth addict. As a result, she is now HIV positive (it tends to promote hypersexual activity, while lowering the faculties of reason that say "condoms. Now THERE'S a good idea in this situation.") and has very few teeth. She detoxed in jail, and while we've supported her, she's for all intents and purposes uninsurable. Medicare and Medicaid provide some help, but the doctors don't seem as good as the ones my insured family members see and effective drugs and treatments for her HIV are effectively a joke beacuse they just aren't fiscally viable for her. (She's also unemployed, becuase who employs HIV positive addicts when there's 15% unemployment already, which there is where she lives.) Every time the family discusses her situation, my immediate reaction is that it just wouldn't happen on the NHS. With the drugs and treatment, she'd have the ability to try to get a job, rather than being ill all the time. She could at least be well enough to do community service and volunteer and keep busy, which would help keep her off the crystal meth.
She's a tragic case, the kind where it would be very easy for a lot of people to say "yup, it is ok to let her die." I can see that logic. But since she is alive, for her to have any hope of giving back to the community, she needs health care, which she just won't get at any level she can afford.
I wonder often if this sort of thing is how epidemics of AIDS and other diseases (not just sexual ones) can continue to spread quite rapidly. I remember tales of the early days of the epidemic where since people either couldn't afford blood testing or else didn't want it to appear on their insurance that they'd even been tested as it would raise their premiums to admit they'd engaged in risky behaviour so instead they'd donate blood and hope that if they were positive the clinic would call them when the clinic had tested the blood. It strikes me that this is no way to preserve public health, in so many ways and I wonder what implications it will have when and if swine flu or what comes next turns more virulent and fatal.
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And Jesus said 'the greatest commandments are these: Love the Lord your God with 10% of your time and energy, and Pamphlet your neighbour with tracts' - Birdseye
Posts: 1250 | Registered: Jan 2009
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Og: Thread Killer
Ship's token CN Mennonite
# 3200
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Posted
At issue up here for us is costs, not who is funding it.
As long as the Doctors are the most powerful union in Canada, we will continue to plough more and more money into the system, without getting much better then the good system we have now. IIRC, labour eats up the largest portion of our costs now - not drug costs.
Even the most right wing of governments up here did not try to break the Doctor's hold over who gets to practice where and for how much money. And, yet, we keep talking about reducing costs without getting at the root issue here.
We don't have the same reverance for Doctors as we had about 30 years ago, when they were regularly elected to Parliament along with the lawyers. But, nobody wants to fight them and I'm not exactly sure why.
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I wish I was seeking justice loving mercy and walking humbly but... "Cease to lament for that thou canst not help, And study help for that which thou lament'st."
Posts: 5025 | From: Toronto | Registered: Aug 2002
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Sober Preacher's Kid
Presbymethegationalist
# 12699
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Posted
I disagree Og. Drugs have overtaken doctors as the most expensive part of medical expenses in total. As working-age people don't receive drugs under medicare except in hospitals or doctor's offices, that may be the only saving grace.
Actually, Canadian billing rates for physicians are significantly lower than US billing rates. The rock of the Medical profession meets the hard place the Ministry of Health.
Medicare actually does a good job of keeping billing rates in line.
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NDP Federal Convention Ottawa 2018: A random assortment of Prots and Trots.
Posts: 7646 | From: Peterborough, Upper Canada | Registered: Jun 2007
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RadicalWhig
Shipmate
# 13190
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Posted
quote:
Originally posted by Hawk:
Could you explain to me the difference between the two [direct public provision & public single payer]? I assumed NHS was single-payer.
The NHS is not a single-payer system. It is a direct public provision system. Care is delivered through public agencies, and the health care professionals are ultimately public employees.
In a public single-payer system, the hospitals might be provided by the State, local authorities, non-profit foundations, or private companies, while the general practitioners and other health care professionals would be essentially independent professionals with their own "cabinets". There would be a national, universal public insurance scheme which would cover everyone, and the individual would then be able to see the doctor or specialist of their choice, secure in the knowledge that the State insurance scheme will pick up the tab.
I think of it this way. Imagine you need lunch. The NHS is a soup kitchen. You turn up, you get what you are given, when you are given it, and you are bloody thankful (ignoring the fact that you have made a substantial contribution for it through taxes anyway). There are no condiments. BUT - you do get fed, you do get kept alive, and you don't have to pay for it up front. A Single Payer system, on the other hand, is like having your choice of restaurant. You go in, you choose what you want, and then, when it comes to pay, the universal public insurance scheme pays for you. You still get fed, you still get kept alive, and you still don't have to pay for it up front.
In practice, some Single Payer schemes do have a co-pay element. If I recall correctly, in France the state paid directly for 80% of my wife's treatments on her "carte vitale"; the other 20% we had to pay up front and then claim back on a private scheme. However, co-pays are not essential to the principle of the single payer system. The essential principle is that it is universal, publicly funded, but delivered through the patient's choice of competing providers.
quote:
Originally posted by Hawk:
Is this the only reason why the French can treat your wife quicker and better, because you're paying for part of it? Or is their system of managing the service just less cumbersome and overstretched than the NHS?
I think the difference is choice and directness. In the UK, if you want to see a specialist, you have to go to your GP, get a referral, and then wait for your number to come up. You will be given an appointment when it suits them. In France, you call up your specialist (it is normal for people, especially those with an on-going condition, to have a specialist of their choice on hand) and book an appointment to suit you. Is this just because there is more money in the system? No. It is because the system is more flexible, being designed around the patient's choice rather than the bureaucratic convenience of a public service provider.
quote:
Originally posted by Hawk:
Do you know any other details of how the French system works other than your personal experience as an end user?
No. I have not studied the detailed inner workings of the French system. My only experience of it is as an end-user.
quote:
Originally posted by Amorya:
The key point of the NHS, for me, is to know that you will never be hit by a surprise bill for being ill. <snip>
It guarantees that however much of a mess I get into, I won't have to pay loads to sort it out.
The same is true under a single-payer system.
quote:
Originally posted by Amorya:
That's why I love the NHS. It's good enough, even if it's not absolutely super.
But surely, even if something is "not absolutely super", we can do better. Why be satisfied with "good enough" when it comes to health care? And actually, for people with chronic but non-life threatening conditions, the NHS often isn't "good enough".
quote:
Originally posted by Amorya:
But the thing is, we have private healthcare here too, if you want to jump NHS queues or whatever, and you can get insurance to cover it. Surely that's the best of both worlds?
No, not really. Firstly, because you in effect pay twice - once through your taxation for the NHS, then again through your private insurance. Secondly, because the costs of "going private" are so high - choice is not built into the public system (because it is a "single provider" rather than "single payer" scheme), and to get choice you have to go outside the public system at vast expense.
In The Orange Book: Reclaiming Liberalism, the Liberal Democrat MP David Laws makes a detailed proposal for replacing the NHS (National Health Service) with a NHIS (National Health Insurance Scheme) - essentially, replacing a direct public provision system with a single payer system. To me, he makes the case seem quite compelling and I cannot find any serious objection to it. Perhaps I'm missing something? Has anyone else read it?
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Radical Whiggery for Beginners: "Trampling on the Common Prayer Book, talking against the Scriptures, commending Commonwealths, justifying the murder of King Charles I, railing against priests in general." (Sir Arthur Charlett on John Toland, 1695)
Posts: 3193 | From: Scotland | Registered: Nov 2007
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Og: Thread Killer
Ship's token CN Mennonite
# 3200
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Posted
quote:
Originally posted by Sober Preacher's Kid:
I disagree Og. Drugs have overtaken doctors as the most expensive part of medical expenses in total.
...
Hmmm....I trust your local knowledge on this. I still think the doctor's union is making it expensive in total due to their unwillingness to let people settle where they want to practice and the very closed shop approach they have about people from other jurisdictions (Doctor trained in Ontario, practices in Michigan, can't work in Ontario).
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I wish I was seeking justice loving mercy and walking humbly but... "Cease to lament for that thou canst not help, And study help for that which thou lament'st."
Posts: 5025 | From: Toronto | Registered: Aug 2002
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CorgiGreta
Shipmate
# 443
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Posted
New Yorker,
In light of your post, which correctly describes the status of the various plans, could you clarify the meaning of Mrs. Palin's reference to " Obama's [emphasis added] death panel". I can come up with only these options:
1. She is uninformed/misinformed
2. She is a liar
3. She is a demagogue
4. All of the above
Greta
Posts: 3677 | Registered: Jun 2001
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Crœsos
Shipmate
# 238
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Posted
quote:
Originally posted by CorgiGreta:
New Yorker,
In light of your post, which correctly describes the status of the various plans, could you clarify the meaning of Mrs. Palin's reference to " Obama's [emphasis added] death panel". I can come up with only these options:
1. She is uninformed/misinformed
2. She is a liar
3. She is a demagogue
4. All of the above
Greta
Blogger Fred Clark recently had a long blog post about option #2 above. Actually it's mostly about how hard it is to find someone willing to simply come out and say "she's lying" in public discourse, usually tying themselves into pretzels to avoid the L-word.
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Humani nil a me alienum puto
Posts: 10706 | From: Sardis, Lydia | Registered: May 2001
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Horseman Bree
Shipmate
# 5290
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Posted
I moved over to The Real Live Preacher, and was interested to see this blog entry .
The second paragraph seems to be related to the discussion above, and the whole thing is not very far off.
Posts: 5372 | From: more herring choker than bluenose | Registered: Dec 2003
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barrea
Shipmate
# 3211
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Posted
I can only speak as I find,and I have always found the NHS to be there when I meed it.
As I am now 82 I have to take lots of different tablets to keep me going and so does my wife.
We would never be able to afford them if we had to pay for them.
Everything that we get now is free including visits to doctors and treatments, operations and
tests etc.
We had to pay our National insurance payments every month while we where at work for many years but now when need it more the NHS is there for us.
I have nothing but admiration for our health system and for the many kind and gracious folk who work in it, including my own son who is a ITU nurse and my granddaughter who is a doctor and has been working for the NHS for 2 years. She is now on the way to Australia to spend 6 months in one of their hopitals
Our Grandson is in his last year at medical school and he should be working as a doctor in the NHS this time next year.
So please don't knock the NHS they are doing a good job.
I feel so sorry for the retired people of America who so often have to go without drugs and treatment that they really need just so that greedy people can make money out of private insurances that many people can't afford to pay.
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Therefore having been justified by faith,we have peace with God through our Lord Jesus Christ.
Romans 5:1
Posts: 1050 | From: england | Registered: Aug 2002
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Imaginary Friend
Real to you
# 186
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Posted
Speaking of knocking the NHS, apparently it's drawing a hefty amount of flak from the opponents of healthcare reform.
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"We had a good team on paper. Unfortunately, the game was played on grass."
Brian Clough
Posts: 9455 | From: Left a bit... Right a bit... | Registered: May 2001
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Honest Ron Bacardi
Shipmate
# 38
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Posted
quote:
Speaking of knocking the NHS, apparently it's drawing a hefty amount of flak from the opponents of healthcare reform.
There must surely be some parallel universe these comments refer to. Surely nobody can get so much wrong at once.
Do American insurance companies refer to their claim assessors as "Death Panels" too?
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Anglo-Cthulhic
Posts: 4857 | From: the corridors of Pah! | Registered: May 2001
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CorgiGreta
Shipmate
# 443
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Posted
I think that there is a good chanace that the angry protests may eventually work in favor of passage a plan along the lines of those proposed.
The public may well be forming a judgment that opponents of the plan are nasty radical extremists, if not a bunch of nut cases.
Shouting down speakers who are attempting to engage in polite, rational discussion of an important matter is not a way to win people over to one's side, and I don't think it willl change the votes of very many, if any, politicians.
If this public image of opponents of health reform becomes set in stone, more moderate opponents will face great difficulty in having their more informed, rational, and less stridently presently objections recognized.
Greta
[ 11. August 2009, 21:49: Message edited by: CorgiGreta ]
Posts: 3677 | Registered: Jun 2001
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Honest Ron Bacardi
Shipmate
# 38
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Posted
Precisely, CorgiGreta. I wondered aloud about that over on the other thread.
Any proposals must be critiqued and examined from every angle - that's how parliamentary opposition can be constructive. This surely represents failure of that model.
Earlier, Erin wrote: quote:
I think what scares a lot of people -- and, quite frankly, it scares the hell out of me, too -- is the idea that the government will just expand our current Medicare program instead of actually putting together some kind of logical system.
It's difficult to interpret all of what is being proposed from afar. But having spent an hour or two trying to understand it better, isn't that more or less what is being proposed?
Obviously I stand to be corrected on that. But if, as it seems, the current level of expenditure is proving painful for US businesses (wasn't this one of the reasons why it was American auto manufacturers teetering on the edge of bankruptcy?), any such plans risk crippling the economy. All this of course being over and above the iniquities already discussed elsewhere.
This sort of healthcare reform opportunity only happens once in a generation, I would guess. If the system needs root and branch reform, now would be the time to do it.
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Anglo-Cthulhic
Posts: 4857 | From: the corridors of Pah! | Registered: May 2001
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Hawk
Semi-social raptor
# 14289
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Posted
Thank you for your detailed answers RadicalWhig. I'm a lot more informed now.
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“We are to find God in what we know, not in what we don't know." Dietrich Bonhoeffer
See my blog for 'interesting' thoughts
Posts: 1739 | From: Oxford, UK | Registered: Nov 2008
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Clint Boggis
Shipmate
# 633
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Posted
From Davelarge's link:
"..Britain's healthcare as 18th in the world, while the US is in 37th place"
So which is better then? AND a lot cheaper!
Why doesn't this settle it, even for the weakest minds?
.
Posts: 1505 | From: south coast | Registered: Jun 2001
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Olaf
Shipmate
# 11804
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Posted
quote:
Originally posted by RadicalWhig:
What is your view?
I am scared to death and quite disappointed that there is actually a significant number of people who are opposed to any action concerning health care. ![[Eek!]](eek.gif)
quote:
Clint Boggis:
Why doesn't this settle it, even for the weakest minds?
Partisan politics mixed up with religious coercion. ![[Disappointed]](graemlins/disappointed.gif)
To fix that problem, we need to rework our entire political system.
Posts: 8953 | From: Ad Midwestem | Registered: Sep 2006
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Macx
Shipmate
# 14532
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Posted
quote:
Originally posted by Erin:
I think what scares a lot of people -- and, quite frankly, it scares the hell out of me, too -- is the idea that the government will just expand our current Medicare program instead of actually putting together some kind of logical system. US Medicare is probably the worst health plan out there, to be honest. They have price controls in place that literally do not even cover the actual cost of the services; there are more regulations to adhere to than the US tax code; they contract through regional carriers and fiscal intermediaries who all interpret Medicare requirements differently, which leaves you screwed if you are like my employer and have three different FIs and another three different carriers to deal with from one billing platform. If what ultimately comes out of all of this is expanded Medicare, I will be the first to take up arms against the government.
Wow! We agree. I'd just add that many of us that know what the Veterans Administration produces and it is . . . well, horiffic is being pretty gentle. When we think of the Government running healthcare, we think of VA healthcare for everybody. I think the vitriol ya'll are hearing comes from a suspicion that Obama wants to nationalize a bastard child of Medicare and the VA system & yup, that would be worth taking up arms over.
quote:
Shouting down speakers who are attempting to engage in polite, rational discussion of an important matter is not a way to win people over to one's side, and I don't think it willl change the votes of very many, if any, politicians.
If those politicians would have listened when they were politely written to, if they would have listened when they were politely spoken to, if they would have listened when they were spoken to a little harshly, if they would have listened when they were spoken to very harshly, it wouldn't have needed to come to that. If the shouting down doesn't get them to listen, perhaps a little violence & if they continue to abuse the people, they may very well encounter extreme violence. You just don't get it Corgi, the people are going to escalate until they are heard & the people don't want another Obama pork factory forced down their throats at the expense of their quality of healthcare.
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Ghosts are always faster in the corners.
Your shipmate,
Macx
Posts: 457 | From: Whittier, Twin Cities, MN | Registered: Feb 2009
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Erin
Meaner than Godzilla
# 2
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Posted
quote:
Originally posted by Macx:
Wow! We agree. I'd just add that many of us that know what the Veterans Administration produces and it is . . . well, horiffic is being pretty gentle. When we think of the Government running healthcare, we think of VA healthcare for everybody. I think the vitriol ya'll are hearing comes from a suspicion that Obama wants to nationalize a bastard child of Medicare and the VA system & yup, that would be worth taking up arms over.
I see two problems here, though -- first, I can't find anywhere there is a proposal to expand Medicare, so it's probably better to actually understand the plan. Second, the right wing has put forth no alternative other than maintain the status quo. One has to be a clinical imbecile to believe that the current system is worth saving. As someone who works in the industry, trying to get reimbursement for services in an organization with one of the lowest overall costs and the best overall patient outcomes, I can honestly say that proponents of the current system are either too stupid to live or 100% pure uncut evil.
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Commandment number one: shut the hell up.
Posts: 17140 | From: 330 miles north of paradise | Registered: Mar 2001
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CorgiGreta
Shipmate
# 443
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Posted
Medicare is not perfect, but there would be rioting in the streets if it were eliminated, and seniors were left at the mercy of private insurance companies.
I have Medicare Advantage, a Social Security plan admistered by a not-for-profit HMO, and I love it. I think that it is an ideal system since the with a non-profit HMO, the focus is upon medicine rather than upon the bottom line.
No paperwork. No bickering over claims. Huge choice of physicians. No profit-motivated tests and treatments or denials thereof. Strong emphasis on preventive medicine. Very affordable generic meds. No rationing panels. No underwriting panels.
Greta
Posts: 3677 | Registered: Jun 2001
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Erin
Meaner than Godzilla
# 2
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Posted
Yeah, that's not what your providers are seeing at all. Unless the HMO is like Kaiser and running the organizations where you're getting your healthcare, non-primary care doctors and facilities get screwed ten ways to Sunday by Medicare HMOs.
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Commandment number one: shut the hell up.
Posts: 17140 | From: 330 miles north of paradise | Registered: Mar 2001
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Amorya
Ship's tame galoot
# 2652
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Posted
quote:
Originally posted by RadicalWhig:
quote:
Originally posted by Amorya:
The key point of the NHS, for me, is to know that you will never be hit by a surprise bill for being ill. <snip>
It guarantees that however much of a mess I get into, I won't have to pay loads to sort it out.
The same is true under a single-payer system.
quote:
Originally posted by Amorya:
That's why I love the NHS. It's good enough, even if it's not absolutely super.
But surely, even if something is "not absolutely super", we can do better. Why be satisfied with "good enough" when it comes to health care? And actually, for people with chronic but non-life threatening conditions, the NHS often isn't "good enough".
Can we do better?
This single payer stuff sounds to me like the promises made when we privatised the railways: competition will provide better service and lower prices. What did we get? A bunch of companies who don't communicate, more late trains than ever before, and costly tickets.
If we had that kind of system for healthcare, while I know the cost wouldn't come into it, I can bet that you'd get some hospitals unable to get your medical history due to their system not being compatible with your GP, and you'd have to fill in a bunch of forms before you got any treatment. Multiple companies tends to breed inefficiency.
I seem to have a similar aversion to private industry controlling things that some vocal Americans seem to have to the government doing it.
Still, single payer would be far better than anything that requires health insurance. I know people in the States whose insurance refused to pay out for spurious reasons like "it was a pre-existing conition". As long as there's a guarantee that that kind of thing cannot happen, I'm happy enough
Amorya
Posts: 2383 | From: Coventry | Registered: Apr 2002
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Sober Preacher's Kid
Presbymethegationalist
# 12699
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Posted
Since RadicalWhig has done a good job of explaining the differences between the NHS and the French system, I hope to clarify what the evil Canadian system does.
The NHS is unusual in that its a pure public provider and was designed and implemented as such from the beginning.
In Canada our system has had a different path since we have the deal with the Federal/Provincial power splits, but the long and the short of it is that the Beveridge Report was just as widely read here as elsewhere and the NHS was always held up in the formative years as the ultimate goal. We started out with a French-style system in the 1960's. The last great round of medicare reform was the Canada Health Act in 1984. This did two things:
1) Extra billing, aka Balance billing was banned. Until then it was a common practice in most provinces. In Ontario its removal prompted a Doctor's Strike.
2) Restrictions on the use of for-profit facilities means that most acute hospitals are non-profit. Long-Term Care facilities are more often for-profit, though non-profit homes are equally common.
The CHA bans private payment for publicly listed services, which means that Canada doesn't have a parallel private system (some minor exceptions, but they are curiosities).
All provinces (who actually run health care) have set up regional health authorities and in Ontario most doctors have moved to Family Health Teams. We've essentially implemented the NHS and didn't tell anyone. This has happened in the last 10 years.
For example, specialists are accessed by family physician referrals, including Pediatricians.
Health Networks have a particular focus on making sure complex cases like Mental Health get focused attention and management.
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NDP Federal Convention Ottawa 2018: A random assortment of Prots and Trots.
Posts: 7646 | From: Peterborough, Upper Canada | Registered: Jun 2007
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CorgiGreta
Shipmate
# 443
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Posted
Erin,
It is Kaiser.
I suppose that I am biased since the extraordinary diligence of one their doctors saved my life a few years ago.
Greta
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Macx
Shipmate
# 14532
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Posted
There is a difference between wanting to maintain the status quo and not wanting to see a program pushed through that the politicians haven't even read entirely yet.
There has got to be a third way, something that includes meaningful reform without perhaps also including free medical care for citizens of other countries illegally within our borders. Maybe a program that isn't run like the VA or loaded with pork for cronies.
Reform would be good, if it was good reform. Bad reform on the other hand, is what is being pushed by his highness of the very expensive bills.
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Ghosts are always faster in the corners.
Your shipmate,
Macx
Posts: 457 | From: Whittier, Twin Cities, MN | Registered: Feb 2009
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Timothy the Obscure
Mostly Friendly
# 292
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Posted
Most liberal economists (Paul Krugman, for example) point to the French system as the best model in terms of value for money.
Most Medicare patients are very satisfied with their coverage. Medicare providers (of which I used to be one, when I was in private practice) are less so--the paperwork is overwhelming, and the bureaucracy (which is not civil servants, but contracted out to private insurance companies) is remarkably stupid and unresponsive.
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When you think of the long and gloomy history of man, you will find more hideous crimes have been committed in the name of obedience than have ever been committed in the name of rebellion.
- C. P. Snow
Posts: 6114 | From: PDX | Registered: May 2001
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five
Shipmate
# 14492
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Posted
Most Medicare patients are satisfied with their coverage? That's news to me. Granted, it is anecdotal, but my stepmother and her friends, and my cousin would happily throw Medicare away if they could get better coverage elsewhere. My stepmother is lucky enough to be in the position where she's able to get health care through work (at 70, she's still working) but at least in our family Medicare (and even then it isn't "free" - without the supplements it seems next to useless from what I can make out) seems just horrible. Finding a doctor who will take it is a problem in itself, and the doctors that do take it seem to be of definitely lower quality and a bit more desperate for patients, which doesn't make anyone feel any better.
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And Jesus said 'the greatest commandments are these: Love the Lord your God with 10% of your time and energy, and Pamphlet your neighbour with tracts' - Birdseye
Posts: 1250 | Registered: Jan 2009
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Moth
Shipmate
# 2589
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Posted
quote:
Originally posted by RadicalWhig:
But surely, even if something is "not absolutely super", we can do better. Why be satisfied with "good enough" when it comes to health care? And actually, for people with chronic but non-life threatening conditions, the NHS often isn't "good enough".
I suspect many of us are afraid of letting the best become the enemy of the good. We think that the French system might well be better, but what we have now works OK, so why risk change? Almost nobody feels sure that change will be worth it, as it carries the risk of going horribly wrong.
Of course, there is an element of this in the debate in America. I can absolutely understand that those with good health care now are going to be very anxious about any kind of change. The idea of some government official rationing your health care is very, very scary. The fact that in practice it's not a government official, but a system with a lot of checks and balances is not easy to explain. As Josephine has explained before on this and other threads, those who have good health insurance and no long-term health problems think the existing system is great (which it is for them).
The British whinging about the NHS doesn't help either. It's easy enough to find examples of rude people and poor care in any system, but Brits do turn whinging into an art form! It's easy to put out scare stories which dampen the effect of the statistics, as most people don't understand or trust statistics anyway.
Anyway, I'm free to come over to the US and help out if you like. I'll bring my sister with her £40,000 cochlea implant and get her to explain how good the NHS can be. Her aftercare has been superb, and she doesn't go through her GP for it - just emails the team at the Royal Ear, Nose and Throat Hospital and they book her in to see them the next day. The NHS can really work when people want it to, just like any system.
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"There are governments that burn books, and then there are those that sell the libraries and shut the universities to anyone who can't pay for a key." Laurie Penny.
Posts: 3446 | From: England | Registered: Apr 2002
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five
Shipmate
# 14492
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Posted
Moth,
You should also take your son as an exhibit. I think part of the problem in the USA is that to become a doctor requires seven years of education, not five, the four of that at undergraduate doesn't have to even be in a science if you take the core requirements for medical school entry as part of your distribution, and the tuition for ALL those years is expensive.
Tuition at medical school is expensive. Up to $75K a year, plus living expenses, plus whatever the previous four years of undergraduate cost you. You can buy a house for what it costs to qualify as a doctor, and not a bad house at that.
By contrast, though she was hardly living large, my sister in law did her medical degree actually as a graduate a couple of years back. Her tuition was the standard £3k per year, and the NHS paid for it. She did more medical education than US doctors get (four years, condensed into a year round programme rather than the standard five) and graduated with an overdraft of £300 since she lived in halls as a tutor while she did it. Every tutor in the university seemed to be in medical school!
So the NHS isn't just providing care, it is providing doctors.
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And Jesus said 'the greatest commandments are these: Love the Lord your God with 10% of your time and energy, and Pamphlet your neighbour with tracts' - Birdseye
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